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Drugs

, Volume 62, Issue 4, pp 567–575 | Cite as

Issues of Adherence to Immunosuppressant Therapy After Solid-Organ Transplantation

  • Marie A. Chisholm
Leading Article

Abstract

Nonadherence to immunosuppressant therapy constitutes a major barrier to post-transplant care. Failure of transplant recipients to take prescribed drugs properly may not only be a significant obstacle to optimal graft function but it may also result in decreased quality of life and productivity, increased morbidity and healthcare cost, and death. Despite the obvious importance of adherence to immunosuppressant therapy, nonadherence is frequent among transplant recipients, with rates ranging from 2 to 68%.

This manuscript briefly discusses several issues concerning adherence to immunosuppressant therapy of solid-organ transplant recipients; presents a literature review concerning adherence to immunosuppressant therapy by solid-organ transplant recipients; and suggests strategies that may be used to enhance medication adherence. Although many of the studies have results that conflict concerning factors associated with immunosuppressive nonadherence, most of the investigators concluded that nonadherent behaviour is usually not predictable. Because of possible adverse events, emphasis should be placed on increasing medication adherence in all transplant recipients.

Keywords

Transplant Recipient Immunosuppressive Therapy Medication Adherence Serum Drug Concentration Medication Nonadherence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work was supported by a grant from the Carlos and Marguerite Mason Trust Fund.

References

  1. 1.
    Sackett DL, Haynes RB. Compliance with therapeutic regimens. Baltimore (MD): Johns Hopkins University Press, 1976Google Scholar
  2. 2.
    Meichenbaum D, Turk DC. Treatment adherence: terminology, incidence, and conceptualization. In: Facilitating treatment adherence: practitioner’s guidebook. New York: Plenum Press, 1987:19–40CrossRefGoogle Scholar
  3. 3.
    Rudd P. In search of the gold standard for compliance measurement. Arch Intern Med 1979; 139: 627–8PubMedCrossRefGoogle Scholar
  4. 4.
    Stewart RB and Caranasos GJ. Medication compliance in the elderly. Med Clin North Am 1989; 73: 1551–63PubMedGoogle Scholar
  5. 5.
    Didlake RH, Dreyfus K, Kerman RH, et al. Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal transplants. Transplant Proc 1988; 20: 63–9PubMedGoogle Scholar
  6. 6.
    Rovelli M, Palmeri D, Vossler E, et al. Noncompliance in organ transplant recipients. Transplant Proc 1989; 21: 833–4PubMedGoogle Scholar
  7. 7.
    Rovelli M, Palmeri D, Vossler E, et al. Noncompliance in renal transplant recipients: evaluation by socioeconomic groups. Transplant Proc 1989; 21: 3979–81PubMedGoogle Scholar
  8. 8.
    Schweizer RT, Rovelli M, Pameri D, et al. Noncompliance in organ transplant recipients. Transplantation 1990; 49: 374–7PubMedCrossRefGoogle Scholar
  9. 9.
    Butkus DE, Meydrech EF, Raju SS. Racial differences in the survival of cadaveric renal allografts: overriding effects of HLA matching socioeconomic factors. N Engl J Med 1992; 327: 840–5PubMedCrossRefGoogle Scholar
  10. 10.
    Kiley DJ, Lam CS, Pollak R. A study of treatment compliance following kidney transplantation. Transplantation 1993; 55: 51–6PubMedCrossRefGoogle Scholar
  11. 11.
    Frazier P, Davis-Ali S, Dahl K. Correlates of noncompliance among renal transplant recipients. Clin Transpl 1994; 8: 550–7Google Scholar
  12. 12.
    Sketris I, Waite N, Grober K, et al. Factors affecting compliance with cyclosporine in adult renal transplant patients. Transplant Proc 1994; 26: 2538–41PubMedGoogle Scholar
  13. 13.
    DeGeest S, Borgermans L, Gemoets H, et al. Incidence, determinants, and consequences of subclinical noncompliance with immunosuppressive therapy in renal transplant recipients. Transplantation 1995; 59: 340–7Google Scholar
  14. 14.
    Hilbrands LB, Hoitsma AJ, Koene RAP. Medication compliance after renal transplantation. Transplantation 1995; 60: 914–20PubMedGoogle Scholar
  15. 15.
    Siegal BR, Greenstein SM. Postrenal transplant compliance from the perspective of African-Americans, Hispanic-Americans, Anglo-Americans. Adv Ren Replace Ther 1997; 4: 46–54PubMedGoogle Scholar
  16. 16.
    Greenstein S, Siegal B. Compliance and noncompliance in patients with a functioning renal transplant: a multicenter study. Transplantation 1998; 66: 1718–26PubMedCrossRefGoogle Scholar
  17. 17.
    Raiz LR, Kilty K, Henry ML, et al. Medication compliance following renal transplantation. Transplantation 1999; 68: 51–5PubMedCrossRefGoogle Scholar
  18. 18.
    Chisholm M, Mulloy L, Jagadeesan M, et al. Impact of clinical pharmacy services on renal transplant patients compliance with immunosuppressive medications. Clin Transplant 2001; 15: 330–6PubMedCrossRefGoogle Scholar
  19. 19.
    Lanza RP, Cooper DKC. In: Heart transplantation: the present status of orthotopic and heterotopic heart transplantation. Boston (MA): MTP Press, 1984:300Google Scholar
  20. 20.
    Murphy J, Coster G. Issues in Patient Compliance. Drugs 1997; 54(6): 797–800PubMedCrossRefGoogle Scholar
  21. 21.
    Kory L. Non-adherence to immunosuppressive medications: a pilot survey of members of the transplant recipients international organization. Transplant Proc 1999; 31: 14S–5SPubMedCrossRefGoogle Scholar
  22. 22.
    Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health 1980; 6: 113–35PubMedCrossRefGoogle Scholar
  23. 23.
    Nichols-English G, Poirier S. Optimizing adherence to pharmaceutical care plans. Am Pharm 2000; 40: 475–85Google Scholar
  24. 24.
    Bush PT, Lanotti RJ. A children’s health belief model. Med Care 1990; 28: 69–86PubMedCrossRefGoogle Scholar
  25. 25.
    DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment. Arch Intern Med 2000; 60: 2101–7CrossRefGoogle Scholar
  26. 26.
    Douglas S, Blixen C, Bartucci MR. Relationship between pretransplant noncompliance and posttransplant outcomes in renal transplant recipients. J Transpl Coord 1996; 5: 53–8Google Scholar
  27. 27.
    Ramos El, Kasiske BL, Alexander SR, et al. The evaluation of candidates for renal transplantation. Transplantation 1994; 57: 490–7PubMedGoogle Scholar
  28. 28.
    Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med 1984; 199: 258–68Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Department of Clinical and Administrative SciencesUniversity of Georgia College of PharmacyAugustaUSA
  2. 2.Department of MedicineMedical College of Georgia CJ-1020AugustaUSA

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